MEDICARE: RYAN LEE MASTROPAOLO LPTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2306603629	VA
2	103K00000X	Behavior Analyst	RBT-16-17379	VA

General Provider Information

NPI Number	:	1306391040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN LEE MASTROPAOLO LPTA

Provider Business Mailing Address
First Line	:	2806 LEE OAKS PL
Second Line	:	APT 101
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-7345
Country	:	US
Telephone Number	:	207-232-4619
Fax Number	:

Provider Business Practice Location Address
First Line	:	2806 LEE OAKS PL
Second Line	:	APT 101
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-7345
Country	:	US
Telephone Number	:	207-232-4619
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	09/02/2016

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